Provider Demographics
NPI:1558502344
Name:MONROE, DEBORAH LEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEE
Last Name:MONROE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14398 COUNTY ROAD 198
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6929
Mailing Address - Country:US
Mailing Address - Phone:903-561-8040
Mailing Address - Fax:
Practice Address - Street 1:2715 PATIO ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2137
Practice Address - Country:US
Practice Address - Phone:903-295-0099
Practice Address - Fax:903-295-0099
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101056225100000X
TX1045243225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist